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OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations. 相似文献
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Samuel A. Spiegel Angelo Collins Penny J. Gilmer 《Journal of Science Teacher Education》1995,6(4):165-174
This article is based on a paper which received the “Innovations in Teaching Science Teachers” award at the 1995 meeting of
the Association for the Education of Teachers in Science. The award is made possible by Delta Education.
This material is based upon work supported in part by a grant from the National Science Foundation (Grant No. 9253170). Any
opinions, findings, and conclusions or recommendations expressed in this article are those of authors and do not necessarily
reflect the views of the National Science Foundation. 相似文献
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The ability of pigeons to use event durations as remember (R) and forget (F) cues for temporal samples was examined. Pigeons were required to indicate whether a houselight sample stimulus was short (2 sec) or long (6 sec) by pecking a red or a green comparison stimulus. After training with a constant 10-sec delay interval, temporal cues (illumination of the center key) were presented 2 sec after the offset of the temporal samples. For one group, a short (2-sec) temporal cue served as the R cue and a long (6-3ec) temporal cue served as the F cue. This was reversed for a second group of birds. During training, comparison stimuli were always presented following the temporal R cue, but never following the temporal F cue. Tests for the effectiveness of the temporal R and F cues showed that F cues were equally effective in reducing matching accuracy in both groups of birds. It was concluded that pigeons used the duration of the cue to determine whether or not to rehearse the memory code for the temporal sample. 相似文献
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OBJECTIVE: The direct and indirect costs to society from child maltreatment are estimated to be quite high. The costs related to medical care are of interest to professionals serving on medically-oriented child protection teams that conduct medical evaluations of alleged abuse. This study was designed to explore a number of financially related issues on medically-oriented child protection teams specifically examining the team's staffing, funding sources, reimbursement, budgeting, perceived impact of managed health care and their perception of funding stability. METHOD: Mailed survey of medically-oriented child protection teams throughout the United States using a questionnaire that contained 28 items focused on a variety of financial issues; 14 items were drawn from a similar study done 6 years earlier, which allowed for comparison over time. RESULTS: Responses were received from 320 out of 472 organizations, yielding a response rate of 68%. Inclusion criteria were met by 153 responses and were included in the analysis; 22 of these had also responded to the earlier survey. Median total budget was $300,000 and state and local government funding was the largest revenue source (Mdn = 30%, range: 0-100%), followed by patient care generated revenue (Mdn = 20%, range: 0-100%). The mean charge for an evaluation was $283 (SD = 196.11, range: $0-$800). Forty percent of teams indicated that managed care had no impact where as 49% saw a negative impact. Comparisons between the responses to this survey and the one done 1993 demonstrated that teams were seeing about the same number of patients and showed trends towards increased budget amounts and broader inclusion of various health care and non-health care disciplines on the teams. CONCLUSIONS: No single source of funds for such teams has emerged as the uniform solution for all teams. Creative patchworks composed of various funding sources remain the typical solution to the funding needs of medically-oriented child protection teams. 相似文献
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The mapping of sample stimuli onto comparison stimuli and the nature of trial outcomes were factorially manipulated in a delayed matching-to-sample procedure. In the many-to-one condition (MTO), responding to a particular comparison was correct following several sample stimuli, whereas in the one-to-many condition (OTM), responding to several comparison stimuli was correct following a particular sample. Probabilities of reinforcement for correct responding to comparison stimuli were either differential (DO) or nondifferential (NDO). Four groups of pigeons were trained under four combinations of mapping and outcome conditions, MTO-DO, MTO-NDO, OTM-DO, and OTM-NDO. Testing at delay intervals of 1, 2, 4, and 8 sec revealed significant effects due to both the mapping variable and the differential outcomes variable. It was argued that the poorer performance obtained in the OTM condition was due to the differential prospective coding requirements placed on reference and working memory by this mapping. In the OTM conditions, a greater number of response codes had to be retrieved from reference memory and multiple response codes may have overburdened working memory, which has a limited capacity. 相似文献
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Matteo Vidali Enrica Verzotti Nicole Cabraz Francesca Santi Alessia Puma Giorgio Bellomo Alessandro Lupi Giuseppe Lippi Gian Carlo Avanzi 《Biochemia medica : ?asopis Hrvatskoga dru?tva medicinskih biokemi?ara / HDMB》2015,25(3):421-429